A video is below at the end of this article. It shows how to hold and position your baby to lessen spit ups.
Effortless spit ups are very common in newborns and infants.
Vomiting is different, as it involves retching, and is more forceful.
You might also wonder why your baby is so fussy. However, most spitty babies are not fussy. We call them “happy spitters.” Some babies feel heartburn as they burp and spit up, and some even arch their back from the discomfort. If your baby seems better after the spit up or burp, then you’ve solved the problem – for now.
Your spitty baby will likely gain weight well despite spitting up. In the first couple weeks of breastfeeding, while establishing your milk supply, feed him again if he acts hungry after spit ups. His tiny tummy is stretching to accommodate more and more milk.
However, if he’s gaining a lot of weight over time, perhaps use the binky a bit more instead of re-feeding. Some babies need a binky to settle. You may be confused when sorting out if your baby is spitting up because he’s over-eating, or if he’s over-eating because he spits up!
When your healthy baby gags and coughs with spit ups, you know his gag reflex is working well to protect his airway. Of course, call if he has trouble breathing, coughing, wheezing, or turns blue or pale.
So what IS “normal?”
Spit up may launch from your baby’s mouth or nose and land in a puddle, or it might dribble over his chin after a wet burp. It might gather in his throat and make him gag, chew, and re-swallow. Your baby might spit up a couple times per day, several times per feeding, or randomly – even before the next feeding. Some days are worse for no reason, but there are good days in between. The spit up can look like fresh milk, curdled milk, or water. Or, the spit up milk can look yellow, green or bluish.Causes of reflux
The valve between the esophagus (food tube) and the stomach is often immature and loose in newborns, and it tightens over the first several months of life. Your baby’s tummy gets full after a feeding. If you accidentally put pressure on his tummy, the milk is pushed upward through the loose valve. This often happens when your baby sits in a car seat, or if he slouches into a tummy crunch while you burp or hold him. Your baby may also spit up due to gravity, when you lay him on his back for a diaper change.Excess air bubbles sitting on top of a tummy full of milk adds to spit ups. Your baby might gulp air while breastfeeding if the let-down is too fast, often due to an abundant milk supply. Also, if you have an over-supply, the excess high sugar foremilk causes lactose overload, which creates even more gassiness. Be sure to empty a breast so your baby gets hindmilk, too. Click here to learn more about abundant milk supply.
Food sensitivities, most commonly milk intolerance, may contribute to reflux. Gut inflammation slows gut motility, so the milk sits in the stomach longer. As the milk lingers near the loose valve at the top of the stomach, it can reflux upward as described above. Click here to learn more about food intolerance.
Rarely, abnormal intestinal anatomy causes excessive spitting, or more likely vomiting. These conditions typically cause progressive worsening symptoms over a few days, without “good days” in between. Abdominal ultrasound or upper GI barium testing can diagnose the problem.
- Pyloric stenosis is rare, and typically presents around 6 weeks of age. The valve at the end of the stomach is too tight, so milk can't pass through to the small intestine. This requires surgery.
- Intestinal malrotation is even more rare. Intestinal anatomy is set up incorrectly so the intestines easily twist upon themselves. This also requires surgery.
Management of reflux
Time, patience and understanding are critical to endure reflux. Most babies outgrow it by 1 year of age.Burp frequently. Your baby may spit up with the burp anyway, but at least you’re ready for it!
Avoid pressure on your baby’s tummy by keeping his back straight!
· Don’t allow a tummy crunch, slouching, or let his knees push into his belly.
· Avoid tight diapers and waist bands.
Position your baby upright for several minutes after feedings.
Do not elevate the head of the bed. Lay your baby to sleep on a flat surface on his back.
Lean back while nursing to slow the milk flow if your baby gulps air during a fast let-down.
If you have an over-supply of milk, make sure your baby gets the hindmilk, and not excess foremilk.
Consider smaller more frequent feedings, and perhaps limit feeding volumes if your baby is gaining too much weight. If you breastfeed on demand as recommended, you can’t measure the milk, so it’s difficult to judge small frequent feedings. Don’t limit feedings when breastfeeding unless you’re certain that weight gain is good.
Consider an elimination diet if a food intolerance is thought to contribute to reflux.
Rarely, someone may suggest you thicken the milk with cereal to help keep it down. This is only possible if you bottle feed.
A trial of antacid medication can be considered if other management strategies fail to improve the fussiness, if your baby fails to gain adequate weight, or if your baby develops symptoms of aspiration.
- Antacid drugs are a last resort, because they eliminate acid. Acid kills bacteria, so it is part of your baby’s immune system.
- There has been some concern that antacid use is related to future food allergies.
Rarely, X-ray or lab tests are done to look for specific conditions that might be causing progressive reflux, that evolves into unlrelenting vomiting.
Sometimes surgery or medical treatments are necessary, as noted above.
Watch this video to learn how to position your baby while holding and burping.
Kay Anderson MD, IBCLC
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